Mortality and Morbidity Among Adult Liver Retransplant Recipients.
Mortality and Morbidity Among Adult Liver Retransplant Recipients.
复制标题
成人肝脏再移植受者的死亡率和发病率。
DOI：
10.1007/s10620-023-08065-2
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发表时间：
2023
影响因子：
3.1
通讯作者：
Lee,WilliamM
中科院分区：
文献类型：
--
作者：
Dakroub,Ali;Anouti,Ahmad;Cotter,ThomasG;Lee,WilliamM
肝移植（LT）是终末期肝衰竭患者的救命手术，高达20%的患者在初次移植后出现移植物衰竭。再移植（ReLT）仍然是不可逆移植物衰竭的唯一确定治疗方法。目的探讨肝移植术后的预后。方法采用移植受者科学登记处（SRTRs）对2003年至2016年间接受肝移植的患者进行回顾性分析。根据既往肝移植史对患者进行分层。本研究的主要结果是5年术后死亡率、发病率和住院时间。结果60554例（96%）受体为首次肝移植受体，2524例（4%）为肾移植受体。多因素分析显示，与首次肝移植相比，ReLT受者的死亡率（OR 1.93, 95%CI 1.76-2.12）、总发病率（OR 1.80, 95%CI 1.65-1.96）和住院时间（OR 1.66, 95%CI 1.52-1.81）显著高于首次肝移植受者。心血管（CVD）并发症（OR 1.32, 95%CI 1.08-1.60）、移植物失败（OR 2.18, 95%CI 1.84-2.57）、感染（OR 2.13, 95%CI 1.82-2.50）和出血（OR 2.67, 95%CI 2.00-3.61）的发生率在ReLT接受者中显著更高。与首次肝移植相比，ReLT患者总体5年死亡率（p< 0.001）、心血管疾病并发症（p< 0.001）、感染（p= 0.009）的5年死亡率显著增加，但移植物衰竭（p= 0.3543）没有显著增加。结论：relt与较高的5年死亡率、总发病率、CVD发病率、感染和移植物衰竭相关。由于心血管疾病和感染，ReLT患者的5年死亡率较高。这些结果可用于ReLT术前患者评估和预后咨询。图形抽象
BackgroundLiver transplantation (LT) is life-saving procedure for patients with end-stage liver failure with up to 20% of patients suffering graft failure following primary transplantation. Retransplantation (ReLT) remains the only definitive treatment for irreversible graft failure.AimsWe aimed to explore the postoperative outcomes following liver ReLT.MethodsPatients who had received a liver transplant between 2003 and 2016 were retrospectively identified using the Scientific Registry of Transplant Recipients (SRTRs). Patients were stratified based on previous liver transplant history. The primary outcomes of this study were 5-year postoperative mortality, morbidity, and length of hospital stay following LT.Results60,554 (96%) recipients were first LT recipients and 2524 (4%) were ReLT recipients. Compared with first LT, ReLT recipients had significantly higher rates of mortality (OR 1.93, 95%CI 1.76–2.12), overall morbidity (OR 1.80, 95%CI 1.65–1.96), and prolonged length of stay (OR 1.66, 95%CI 1.52–1.81) on multivariate analysis. Morbidity including cardiovascular (CVD) complications (OR 1.32, 95%CI 1.08–1.60), graft failure (OR 2.18, 95%CI 1.84–2.57), infection (OR 2.13, 95%CI 1.82–2.50), and hemorrhage (OR 2.67, 95%CI 2.00–3.61) were significantly greater in ReLT recipients. Compared to first LT, ReLT patients had a significant increase in overall 5-year mortality (p< 0.001), 5-year mortality due to CVD complications (p< 0.001), infection (p= 0.009), but not graft failure (p= 0.3543).ConclusionReLT is associated with higher rates of 5-year mortality, overall morbidity, CVD morbidity, infection, and graft failure. Higher 5-year mortality in ReLT is due to CVD and infections. These results could be used in preoperative patient assessment and prognostic counseling for ReLT.Graphical Abstract